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Complications: A Surgeon’s Notes on an Imperfect Science

Complications: A Surgeon’s Notes on an Imperfect Science

Написано Atul Gawande

Озвучено William David Griffith


Complications: A Surgeon’s Notes on an Imperfect Science

Написано Atul Gawande

Озвучено William David Griffith

оценки:
4.5/5 (99 оценки)
Длина:
7 hours
Издатель:
Издано:
Mar 1, 2003
ISBN:
9781593970314
Формат:
Аудиокнига

Описание

A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This audio is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is — complicated, perplexing, and profoundly human.

Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.

At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.

Издатель:
Издано:
Mar 1, 2003
ISBN:
9781593970314
Формат:
Аудиокнига

Об авторе

Atul Gawande is the author of four bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto, and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018-2020. He and his wife have three children and live in Newton, Massachusetts.


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4.6
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  • (4/5)
    CBR 10 BINGO Square: Backlog (Added this to my TBR list on February 12, 2013 - the day I joined Goodreads, apparently)Best for: People who enjoy good writing about medical issues. NOT for those who get squeamish reading about surgical procedures.In a nutshell: Surgeon Atul Gawande (you probably know him from Being Mortal; I think my favorite of his is the Checklist Manifesto) shares stories about his time as a surgeon, exploring the reality that surgeons are humans and make mistakes.Worth quoting: “In the medicine, we have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience.”Why I chose it: I can’t believe I haven’t read this yet - I thought I’d read all of his books. So when I sorted my Goodreads list for this CBR10 I was shocked to see it on there. I worried I’d start reading it and realize I’d read it before, but nope. It was new to me!Review:First off - CANNONBALL! My sixth since I started with CBR 5. Ah, how the time flies.I enjoyed this book. I think it could have been better organized, but any time I get to read Dr. Gawande’s writing, I know I’m going to learn something and I’m going to enjoy reading it. He’s so talented, it seems unfair - a surgeon who can also write, and write well?This book explores, through three distinct parts, the challenges of medicine that arise because humans are humans who need to learn and who make mistakes. The first section looks at learning and mistakes, the second at trying (and sometimes failing) to solve medical mysteries, and the third focuses on indecision. The book starts off intensely, with Gawande sharing how he learned to put in a central line. It’s quite graphic, and does a great job of getting across the point that we all know somewhere in our mind (or every Thursday night when we watch Grey’s Anatomy): that doctors have to learn somehow. And usually that means performing on patients who are sick and injured. As patients, we want the best to treat us and our families, but the best only get there by practicing, which means that at some point we’re going to get the worst.The second section, on medical mysterious, explores the frustration of healthcare professionals and patients when there is something wrong but we don’t know the cause and don’t know how to fix it. Like, for example, the woman who had nearly uncontrollable nausea for her ENTIRE PREGNANCY. Basically, what the Duchess of Cambridge had, but apparently it never stopped. I just … ack. The final section is a reminder of the fact that sometimes, doctors just don’t know exactly what to do. The last chapter illustrates this amazingly well, with a woman who either has cellulitis or flesh-eating bacteria, and the doctors — and the patient — need to make a decision on the path forward. It looks at how much should doctors be directing care and how much should patients be? How do you find a compromise that respects the choice of the patient but also the knowledge and experience of the doctor?Like I said, it’s an interesting book. It’s not a five-star read for me mostly because the chapters aren’t as well-connected as they could be. But it’s a strong four, because it’s Gawande.
  • (4/5)
    Compelling reading, esp the first few chapters, on the dilemmas and challenges doctors face every day.
  • (5/5)
    I loved this book. My husband, who is a med student, didn't care for the first half and had me skip over it. I got so into the second half that I went back and started reading again from the beginning. The first half was great too, I don't know why I took his advice.It was really interesting to read about the real cases and patients that Gawande has encountered over his career and to learn about them from a doctor's point of view. The general population thinks little about what goes into becoming a surgeon and we put our lives in other people's hands all the time just trusting that they are not having a bad day or are right about their gut instincts. It was scary to read and also thrilling. A must read for anyone in or out of the medical profession.
  • (5/5)
    5***** and a &#10084This National Book Award finalist REALLY makes you think! It opens your eyes to the imperfections in our system of medical care. Gawande is a surgical resident (when he wrote it), a thinker and a poet. He uses case histories to explore the thinking, the philosophy, of medicine. He speaks of mistakes and intuition, luck and skill, good outcomes despite bad treatement, and devastating outcomes despite excellent care. This should be required reading for all medical students and regularly re-read by all MDs.After I'd read it I couldn't stop talking about it, and convinced one of my F2F book clubs to read it in July 2005.
  • (4/5)
    This book reads like a memoir from any principal player from shows like "Untold Tales from the ER," "Medical Mysteries," or the fictional "ER."

    The book breezes along nicely, pausing long enough on the interesting parts and speeding through others to get to the salient information. Dr. Gawande calibrated that very well.

    Also on display is the clear passion of the author to his craft. The narrative is sprinkled with good humor, though it's evident he takes his work, and the writing of the book, seriously.

    Portrayed clearly is the very human side of medicine, which is important for patients to see.

    His summary is simple: We try so hard to help, sometimes we fail, sometimes we succeed, we are so human.
  • (5/5)
    A great book about the science and practice of medicine. Gawande, a surgeon, gives an insider's view of the medical profession, a profession that often appears hard-nosed, but is as beset with ambiguity, uncertainty, human judgements, customs, mistakes, and need for practice and learning as other ones. He is not without recommendations, though: Gawande details the benefits of computer-based diagnoses, specialization, the field of anesthesia's success in reducing human, latent errors by analyzing such errors systematically and comprehensively. Recommended.
  • (4/5)
    I'll knock off half a star because the three sections didn't really seem connected in any way, but each one was fascinating: an examination of how doctors learn and how uncomfortable that is, a description of things medical science just doesn't understand, and some explorations of the inherent uncertainties of dealing with a system as complex as the human body. (Actually, my problem is I wanted every one of those to be its own book.)
  • (4/5)
    This book was a little hard to read at first. It was disturbing to have a doctor describing just how fallible doctors are (himself included). But, once I was a few chapters in I couldn't put it down. So many case studies and examples, it turned out to be such an interesting read!
  • (4/5)
    This is a wonderful book on the many issues that arise in healthcare from the perspective of one of the most introspective doctors around. This book covers many topics that lay people often do not think about in medicine (medical complications, malpractice, etc) until they have to deal with the problems themselves. I have read all of Dr. Gawande's books, and he always provides something interesting to think about.
  • (5/5)
    i learned that we trust our doctors more than we should some times
  • (5/5)
    In Complications: A Surgeon’s Notes on an Imperfect Science, Gawande examines ambiguities and misunderstandings found in medicine. Specifically, he discusses three topics: fallibility, mystery, and uncertainty. Although all three topics and their anecdotes could be completely standalone sections, Gawande uses them to make a grander point regarding the imperfect nature of medicine. Gawande’s primary argument is that although we all desire the best possible care from our doctors, we also need to recognize that the medical field is not a perfect science. Doctors are people, and like people, they make mistakes, are inconsistent, and have flaws. Gawande uses real examples to honestly consider complications in the profession; for example, in one of my favorite sections Gawande points out that every patient wants an experienced doctor, but the only way a young doctor can become experienced is by essentially “practicing” on people. He also highlights that medical decisions are sometimes based on a combination of luck and instinct, and occasionally “I don’t know” is the best answer a doctor can give. Complications was a fascinating read, both well-written and thought-provoking. I highly recommend it.
  • (4/5)
    I think I had already checked this out of the library when a relative landed in the hospital with a heart condition. Gawande is, as the title would imply, quite honest about the limitations of what doctors know about treating illness. Being who I am, this was actually a comforting perspective to hear at a time when we were facing medical uncertainty – it helped me understand better how to ask questions and advocate while also letting go of the need to understand it all – the doctors sure don’t! But I really admire them for being willing to go through epic school and then show up every day to help people face uncertainty with the knowledge they do have.
  • (4/5)

    1 person found this helpful

    Gawande, a surgeon, argues that medicine isn't an exact science and therefore mistakes are inevitable. He then explores the line between that potential for error and the humanity necessary to make doctors good at what they do.This is a good, interesting read with all sorts of worthy insights, and Gawande is an excellent writer. My only issue with it is that I have Surgery/Hospital Fear, and his anecdotes supporting the message of medicine as not infallible really didn't help that. It's, of course, my own shortcoming and not the book's, and I can otherwise happily recommend it.

    1 person found this helpful

  • (4/5)
    Surgeons are fallible, and this book shows how that fallibility plays out in real life. Eye opening,well written, memorable.
  • (4/5)
    I should not have been surprised to learn from the Author's Acknowledgement that Gawande is friends with Malcolm Gladwell -- this book is the doctor's equivalent of a Gladwell book. I really learned a lot from this book and have found myself sharing some of the points with others as I've read it. I should say that Gawande is very graphic in decribing medical procedures and conditions, and there were times I felt a little squeamish (Like reading the chapter on nausea as I was eating lunch; also I'll never be able to hear that TV doctors are about to "put it a line" without wincing) and realized I didn't want to know all this detail, but I'm still glad I read this book.

    Some of my favorite points were:
    That every patient wants an experienced doctor, but the only way a young doctor becomes an experienced doctor is by performing procedures (very much like a teacher).
    The evolutionary purpose of morning sickness
    The role of intuition in medicine
    How some doctor's go "bad"
    The ways doctors try to police themselves
    How much doctors and medical researchers still don't know -- the amount of uncertainty and subjectivity.
    Other doctors have much to learn from palliative doctors, who take the patient's suffering as seriously as the symptoms.

    I also liked reading Gawande's descriptions of his role as a surgical resident -- although how he managed to juggle writing this book with his work and family life (he has a wife and 3 kids) boggles my mind.
  • (4/5)
    Great book. It sagged a bit near the middle (the chapters on blushing and gastric bypass were, in my opinion, the weakest of the bunch). The rest was pretty damn riveting. And I found the section on nausea and vomiting fascinating!
  • (5/5)
    This was a very well written book with some interesting, surprising and shocking insights into the medical industry. One thing Gawande makes very clear throughout the book: doctors are human and thus as fatally flawed as the rest of us! His use of real cases is underpinned by something more striking: his knowledge of his patients as people beyond the hospital. He is not afraid to speak against his peers and admit that there are failings in the medical system itself and with individuals and that there are mistakes made that shouldn't be.Far from leaving me reticent about ever seeing a doctor again, I applaud Gawande's plain speaking and honest admissions. Sadly, we all make mistakes and this is a profession in which mistakes can be both epic and tragic; however, perhaps the bigger tragedy is that fear of being sued for simply doing one's job to the best of one's ability but making a rare error is enough to prevent full open and frank discussion with colleagues and the patients' families to ensure that such mistakes are more easily avoided in the future.In a world of 'Where there's blame, there's a claim' mentality, shouldn't we be assigning some blame to 'ambulance chasers' whose willingness to destroy someone's reputation and perhaps career for the sake of making money could deprive a hospital - and society - of another competent, well-skilled doctor. Not only that but they make it practically impossible for doctors to learn from the errors of others, so great is the fear of admitting 'I made a mistake'.
  • (5/5)
    You expect medicine to be a hard and fast science. Is versus Isn't. Black and white. Cut and dried. Science simple as that. It is hard to imagine medicine as fuzzy, as imperfect and wishy-washy as gray area, but it is. Gawande doesn't apologize for this less-than-exact science. He is pragmatic in his approach - sometimes doctors get it right and well, sometimes they don't. The essays in Complications are scary and humbling. You hear about real cases. Real patients. Everyday people with seemingly normal lives. Your neighbor. You. Then you hear about the scary stuff. Medical mistakes. Doctors deferring decisions to patients. Surgeons operating with their hearts more than their minds...it happens. As hard as some of the information was to digest it was eye opening and a necessary truth.
  • (2/5)
    I guess this just isn't the book for me. I am interested in science writing, but this just seems one more entry in the deification of doctors, like so many TV series or doctor's columns in women's magazine. And as one scientist remarked in discussions about the Jonah Lehrer errors and fabrications, doctors aren't scientists either. The writing is smooth, New Yorker style: a little anecdote interspersed with the teaching nuggets. Nothing too technical or heavy on the science side. Not enough for me.Does anyone else think he should disclose the costs of these surgeries, whether patients have medical insurance, and his own income? (Don't forget, he's also a staff writer for the New Yorker; all it takes is to be friends with the editor of Slate and with Malcolm Gladwell). I guess I have long been sensitive about this but the omission of financial factors was more in the forefront of my mind because I had just read Head Cases by Michael Paul Mason, where a thread throughout is the financial impact of brain injury on families and whether insurance will cover therapies.Most ridiculous examples ... a super-obese working-class man who gets gastric bypass surgery. This might be the only profile in which we're told the surgery at the time cost $20,000. But the man is on the brink of bankruptcy, can't get out of his house and had sold off large equipment. Surely insurance can't be covering this? What is the financial impact on his family.There's all this posturing about the Oh Great Doctors' ethical dilemmas: what should he recommend? Surgery or not? Some mention of the weight of pain and suffering. But *never* a mention of what must loom in the patient's and p's families' minds: "how much will this cost? We can spend up to here but not up to here. How many years to pay this off?"Then there's the case of an elderly Mr. Lazaroff with a tumor around his spine. Already partially paralyzed, he is at risk for more paralysis and ending up on a ventilator until his death. He wants the surgery.We're told that the few weeks of intensive care (what about the hours-long surgery?) incur "enormous" financial costs before his death. I guess the man must have been on Medicare, so no or few worries. But $100,000 on up is a safe guess. Shouldn't that provoke a mite bit of musing of how the money might be better distributed. Breast screening for the working poor? A year of intensive therapy for a young brain-damaged man who might be able to support or take care of himself at the end of it? It would be interesting to see how a doctor under a state-run universal health service would weigh the choices. There is always *rationing* in such systems and the age of a patient is a large factor.Also irritated by the young woman who wanted to be "on TV" but had a blushing issue. Now there are many jobs in broadcast journalism--responsible, well-paying jobs--where blushing wouldn't be a hindrance. But this woman wants to be "on TV" and her dream must be fulfilled, not matter what the cost (not that it's mentioned). How could a young person, perhaps making $20,000 in the late 1990s on a small station afford it? Couldn't have student loans, so must be rich parents. Insurance wouldn't cover this, right?Once upon a time, when the circumstances and the medical care were in reach of most of the middle-class, even the working lower US middle-class, maybe these little pieces could stand alone but nowadays, I think not. And, no, I couldn't afford any of these illnesses,
  • (4/5)
    I've pretty much decided that I would read a telephone directory if this man wrote it. I didn't think there could be a, well, better book than his previous work, Better, but I think this tops it. Complications is about the imperfections in medicine -- the unexplained mysteries, the screw ups and the inconsistencies in decision-making. Reading this book is almost like being faced with a terrifying medical decision for a loved one, but while you face it Gawande has his hand on your shoulder. His compassion and wonder at what we don't understand about the human condition -- both of patients and of doctors -- is on full view -- but in such a way that you feel hopeful and brave. The chapters about morbidly obese patients, and also the one about doctors who have "gone wrong" are written with respect and almost tenderness that is as touching as it is illuminating and clear-eyed.
  • (5/5)
    It is such a pleasure to read Atul Gawande's prose. His style is accessible to laypeople but technical enough for those in the profession to learn something from his experiences. Each chapter addresses one medical area of "imperfection." Some examples: the fact that student doctors inevitably must learn on living people, the medical profession's cloudy understanding of pain and nausea, and the fact that just as in other professions, some doctors are "bad".A blurb in the front cover of the book states that Gawande's book "reads like a thriller," and I think this is a very apt description. He uses cases from his experience as a surgical resident to illustrate his points, and it is clear from his writing how invested he is in his patients. He brings the reader into that sense of investment, so I found myself really needing to know how each patient's case was resolved.I think that those who are interested in the medical profession or simply want some insight into the field will get a lot from this book.
  • (4/5)
    Great. Reminds me of why I wanted to do medicine.
  • (4/5)
    Various essays and stories on the more complicated part of medicine. He covered everything from obesity and gastric bypass surgery, to chronic pain and end of life decisions. The surgery to correct blushing was very interesting. Lots to think about in here, but maybe don't read if you are expecting to have surgery in the near future. It will just freak you out.
  • (5/5)
    An excellent collection of essays (they need not be read in order). Atul Gawande is a great writer and his method was very approachable; you don't have to be a doctor to understand and appreciate what he's trying to say. He also has a talent for making you feel like you're right there by the body, watching what's happening -- maybe not such a good thing for those with squeamish stomachs.I think I will recommend specific essays from the book to friends of mine. The ones on chronic pain, gastric bypass and "when good doctors go bad" should interest a wide audience.
  • (4/5)
    A brief, eloquent, and thoughtful book that describes the messy and occasionally miraculous business of surgery and traces the author's own development from greenhorn resident to accredited surgeon. Clearly written for a general audience, "Complications" makes surgery seem like a very human endeavor, not the domain of mysterious, infallible wise men in white coats. In Gawande's telling, surgery full of unknowns and anxiety for both the doctors and their patients, it takes a great deal practice to get good at it, and everyone involved is faced with tough choices that they sometimes come to regret. The author never seems to forget that both the doctors and patients he describes were people before the operating table and have lives to go back to after the surgery is finished. Gawande makes a point of putting the practice of surgery in a larger context and takes several chapters to describe how new technologies and current social trends, like the idea that patients should have the final say about their treatment, have affected the way doctors do things. While he's aware that he has his own professional prejudices, his descriptions of these debates seem admirably fair minded and sensitive to his patients' interests. Gawande's book also might give some readers a new perspective on their own bodies. While we tend to think that we know our own bodies pretty well, it's fair to say that surgeons have seen more of more human bodies than most people have, or care to. His descriptions of surgical procedures are clear and straightforward and free of unnecessarily technical language The author deserves some credit for not going in for shock value, even when he describes operations that would amaze doctors that practiced just a few decades ago. The human body, which is, perhaps, the real main character of "Complications" is made to look both eminently functional and endlessly strange, sometimes too delicate and sometimes surprisingly resilient, Gawande succeeds, I think, in convincing his readers that its thanks to the surgeons like him that we know as much about it as we do.
  • (4/5)
    Brief Overview: The subtitle of the book pretty much says it all: “A Surgeon’s Notes on an Imperfect Science.”My Thoughts: First things first, I wouldn’t recommend reading this book if you or a loved one are scheduled for surgery as Gawande is utterly forthright about the fallibility of physicians (and surgeons in particular). As much as we like to believe that our doctors know what they are doing, Gawande reveals that, all too often, medicine is a combination of luck, guesswork, timing and instinct. After all, physicians are human and prone to the same weaknesses as the rest of us: pride, arrogance, fatigue and distraction. But Gawande doesn’t just focus on the “hidden” side of surgery, he also explores how much of medicine is just plain mysterious—that some conditions just don’t “follow the rules” or behave as expected. This was a fascinating and gripping read, and I highly recommend it. However, as I said at the start, it may not be the best choice if you’re about to undergo surgery. The book was a finalist for the National Book Award, and Gawande also wrote Better: A Surgeon’s Notes on Performance, which I fully intend to read.
  • (5/5)
    For anyone interested in the world of medicine and doctors, I heartily recommend this eloquently written and fascinating book of medical essays. At the time Dr. Atul Guwande wrote this book, he had been a surgical resident at a Boston hospital. The book is divided into three parts, each dealing with different facets of “complications” in modern medicine. My guess is that, for the general public, the middle section of the book, the part which addresses medical superstition, pain, nausea, blushing, and morbid obesity, would be the most interesting. For me, however, I was more captivated by the topic of fallibility of the world of medicine. I like how Dr. Guwande tackled this subject head on in a forthright and honest manner. Some of the subjects with which he deals through the book are unintentional medical errors, medical errors made through inexperience, medical diagnostic intuition, and the decreasing use of autopsies to correlate the cause of death diagnosis. Each topic he discusses is a world unto itself, fully described and offering much food for thought. I think a book such as this one is important for a variety of reasons. It is a way for patients to understand a different side of medicine. It “humanizes” medical practitioners who often no longer have the time to “really” get to know their patients. However, the most important reason for an individual to read this book would be to see how important it is for each person to be an advocate for his or her own health care. Patients and doctors should be full partners in medical care with both sides bringing honesty and thoughtful consideration into the course of any medical treatment.
  • (5/5)
    This book was selected by a reading group on Twitter (#lrnbk) that focused on books "about how learners learn". It's not a book I would have picked up otherwise, but am glad I did. Through the author's telling of how he came to be a doctor you find out more about how doctors/medical students learn how to do what they do. The reality of "practice" in hospitals and doctor's offices can be difficult to read, but worth the time to do so. Gawande also introduces some of the most effective ways in which doctor's learn, such as in teams, and provides examples and stories of the good and bad from his experience.
  • (4/5)
    The man is amazing, surgeon, gifted writer, father, and he seems to track down the subjects of his essays years later regularly. Some good insights into what medicine is doing, and what its limits are.
  • (4/5)
    Compelling accounts of a surgeon's experiences some of which originally appeared in The New Yorker. I was particularly moved by the chapters on pain and nausea.